Once-a-week lower hemibody irradiation (HBI) for metastatic cancers

Hemibody irradiation (HBI) of 8 Gy has been shown to produce pain relief in widespread metastatic disease. The major problems occurred with high dose (over 6 Gy) to the upper hemibody. Because 8 Gy lower HBI was well tolerated, we decided to study the efficacy and tolerance of even higher radiation doses given to the lower hemibody. Nineteen patients with widespread metastatic cancers in the lower hemibody were treated from 1982 to 1984 with 16 Gy (8 Gy one week apart) to the lower hemibody (from top of iliac crest to knee joint) after premedication with an antiemetic. All the patients tolerated this high dose, lower HBI well, except for two patients who had slight nausea and vomiting, and one patient who had moist reaction in the perineum. There was no significant bone marrow depression. All patients had improvement in performance status and had prompt pain relief, ten (53%) with complete pain relief and nine (47%) with partial pain relief. The median duration of pain relief was 5 months. Ten of the 15 patients who died were pain-free at the time of death. The four patients still living are free of pain. The median survival was 7 months, and five patients survived 1 year. High dose (8 Gy X 2 spaced one week apart), lower HBI produces prolonged, prompt and effective palliation of pain with minimal morbidity and is well tolerated. It probably does not prolong survival. Because it requires only two treatments spaced one week apart, it is a very convenient and cost effective regimen for the sick and elderly patient.